Mavani Parit T, Goyal Subir, Hogg Melissa E, Kamath Ashwin S, Iannitti David A, Simo Kerri A, Helton W Scott, E Serrano Pablo, Onkeni Edwin O, Geller David A, Polanco Patricio M, El-Hayek Kevin, Warner Susanne G, Cleary Sean P, Alseidi Adnan, Zaidi Mohammad Y, Russell Maria C, Maegawa Felipe, Nguyen Kevin T, Sarmiento Juan M, Maithel Shishir K, Kooby David A, Shah Mihir M
Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA.
Biostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Surg Endosc. 2025 Sep 11. doi: 10.1007/s00464-025-12184-4.
Minimally invasive liver resection (MILR) is associated with fewer postoperative complications compared to open liver resection. Eastern Cooperative Oncology Group (ECOG) performance status (PS) is a fast, reproducible patient selection tool used to guide therapy. We compared patient outcomes after MILR by ECOG PS.
Non-cirrhotic patients undergoing MILR resection at one of 14 North American healthcare centers were identified from the Americas Minimally Invasive Liver Surgery (AMILES) database (2010-2024). Perioperative outcomes were compared between ECOG1 and ECOG2 patients. Multivariable analysis (MVA) was used to identify factors independently associated with postoperative complications.
Of 4,181 patients, 486 met our inclusion criteria. Median patient age was 62 years. Four-hundred twenty-eight patients (88.1%) were ECOG1. Overall postoperative complication rate was not lower in ECOG 1 patients compared to ECOG 2 patients on univariate (20.3 vs. 29.1%, p = 0.17), and MVA (aOR 0.60, p = 0.14). Robotic versus laparoscopic approach (aOR 0.52, p = 0.03) and use of intraoperative ablation versus no ablation (aOR 0.38, p = 0.03) were associated with decreased odds of postoperative complications. Intraoperative conversion from MILR to open was associated with increased odds of postoperative complications (aOR 2.22, p = 0.04).
In non-cirrhotic patients with ECOG2 performance status, minimally invasive minor liver resection may be considered with an acceptable complication rate similar to ECOG1 patients.
与开放性肝切除术相比，微创肝切除术（MILR）术后并发症更少。东部肿瘤协作组（ECOG）体能状态（PS）是一种快速、可重复的患者选择工具，用于指导治疗。我们比较了根据ECOG PS进行MILR术后的患者结局。
从美洲微创肝脏手术（AMILES）数据库（2010 - 2024年）中识别出在北美14个医疗中心之一接受MILR切除术的非肝硬化患者。比较了ECOG1和ECOG2患者的围手术期结局。采用多变量分析（MVA）来确定与术后并发症独立相关的因素。
在4181例患者中，486例符合我们的纳入标准。患者中位年龄为62岁。428例患者（88.1%）为ECOG1。单因素分析时，ECOG 1患者的总体术后并发症发生率并不低于ECOG 2患者（20.3%对29.1%，p = 0.17），多变量分析时亦是如此（调整后比值比[aOR]为0.60，p = 0.14）。机器人手术与腹腔镜手术方式（aOR 0.52，p = 0.03）以及术中使用消融与未使用消融（aOR 0.38，p = 0.03）与术后并发症几率降低相关。术中从MILR转为开放手术与术后并发症几率增加相关（aOR 2.22，p = 0.04）。
对于ECOG2体能状态的非肝硬化患者，可考虑进行微创小肝切除术，其并发症发生率与ECOG1患者相似，可接受。
